YORK Hospital is set to lose £10 million this year - the equivalent of funding ten wards or 100 consultants for a year - due to NHS fines.
Penalties imposed on hospitals for missing government targets over emergency cases has already cost York Hospital £2.5 million in the first three months of this year and is on target to come to £10 million.
The tough penalties come alongside escalating financial pressure on the trust, which has delivered tens of millions of pounds of savings since 2009 - and must find another £25 million in savings this year.
Patrick Crowley, chief executive of York Teaching Hospital NHS Foundation Trust, said: "We are constantly looking to do more for less.
"At this stage of the year we're marginally in deficit, which isn't a position we usually find ourselves in or we're comfortable with. What we're seeing across the country is increasing numbers of hospitals going into deficit and there are a number already in significant problems. My general view is - it's not if, it's when, in the current state of affairs."
Last year the hospital lost £8.5 million due to financial penalties imposed on A&E - including a policy of non payment if a patient is readmitted within 30 days of being discharged, and a cap on the number of admissions they can have, meaning the department is only paid 30 per cent of the full cost of treating the patient thereafter.
The issue was raised in a Channel 4 Dispatches programme, after which Vale of York CCG said it would ensure money kept from the hospital would be effectively reinvested - something which is not happening, Mr Crowley said.
He said: "It's a systemic issue, not an issue of A&E. The problems in A&E are a symptom of the system and not a problem of A&E in itself.
"I would want to see that £10 million being invested and that would need to be either paid over to the hospital to invest in our hospital services and I believe that should be the case or invested in alternatives to reduce the demand in hospital services.
"What I don't think I could ever be satisfied is we're de-funded or not paid £10 million and nothing happens.
"There is an obligation on the CCG to invest the savings they make.
"That simply isn't happening."
However a spokesperson for North Yorkshire and Humber Commissioning Support Unit disagreed - stating that while historically the Primary Care Trust and CCG did not clearly identify the monies kept from the hospital, it has this year identified out of hospital programmes that are aimed at preventing urgent care admissions. They said a new "five year plan" would see "the system change that will ensure our local community receives the best possible healthcare."
Meanwhile, the overwhelming pressure on A&E last year meant that 2800 patients arriving by ambulance waited between 30 and 60 minutes in York and Scarborough hospitals before A&E staff were able to deal with them.
Nine hundred waited more than an hour and 51 in York waited more than two hours. A new waiting facility in York has been built so ambulances can off load patients more quickly.
Mr Crowley, who oversees the Trust-wide budget of over £400 million, has warned of "huge problems" in the NHS nationally, which is projecting a £30 billion shortfall in a number of years.
He said: "The current strategy is to look to integrate services, invest in services in the community, reduce pressure in the hospital and use our services wisely and there is this belief - almost a mantra - that will then provide sustainable finances for the NHS.
"There is no evidence to suggest that will be the case and I personally don't believe it can be the case. I am a huge advocate for integrating services but I don't believe that will provide the financial salvation many claim it's going to.
"It's getting worse, it will get worse before it gets better."
Seventy per cent of the hospital spend is on staff and he said that while jobs would always look to be protected, "there will be pressure" if the financial situation worsens.
But he said "it's not all doom and gloom" and ambitious plans for the future of the hospital included looking to develop new cardiac facilities, theatres, endoscopy and acute assessment areas.
Mr Crowley said: "My general view is the moment you stop planning with ambition is the moment you start giving up on your services and things start to get worse. We will always try to do the best with what we've got."
Disparities with NHS discussed
A POSTCODE lottery meant more people who had gastric band surgery at York Hospital lived outside of North Yorkshire than within it.
Differences between Clinical Commissioning Group thresholds meant that people with a lower BMI from outside the county were entitled to the weight loss operations people in it were not.
Mr Crowley said: “It was harder as a York resident to access the bariatric service than it was for a resident from another part of the country.”
Discussing other disparities, – such as York being the only place in the UK not to offer IVF and the withdrawal of funding for pain relief injections for some people – Mr Crowley made the point that a discussion needed to be held over what the NHS could and could not offer. He said the inconsistencies showed a “creeping rationalisation” where “some people will choose to pay and others will go without.”
Mr Crowley said: “The NHS will continue to have a good record in managing the acutely ill.
“Finances never come into consideration in managing the most acutely ill.
“What I think what might happen in the future is there will be a debate on what the NHS can provide and that will affect planned care, planned operations, and treatments.
He added: “The NHS should be free at the point of delivery and I agree with that.
“That’s not to say the NHS can and should provide everything people feel they should.
“If we’re going to provide what we currently provide to an increasingly high standard you would argue there should be more finance in the system.
“If you agree that’s not possible there will have to be discussions about some things not being affordable on the NHS – I can’t see that not being an option.”
Pay rise for A&E docs
“Bonuses” for A&E doctors DESPITE suffering financial hardship, York Hospital has confirmed it is looking to offer higher salaries to A&E doctors to attract staff.
Middle grade doctors on £37,176 to £69,325 could be offered an extra 10 or 15 per cent of their salary to work in York’s emergency department which is continually recruiting due to the high pressure environment and anti-social working hours.
Mr Crowley said: “Its hard pressed, it’s one of the few 24 hour services. The harder it is to recruit, the more we expect forfrom the people we have.
“It becomes a self fulfilling prophecy – the fewer we have makes it even less attractive as a job. In terms of the modern day expectations – fewer people are willing to work around the clock.
“We have an ability to decide whether we offer the going rate salary wise. All our salaries are paid under national terms and conditions but if we find a post is difficult to recruit for we can pay a recruitment or retention payment which lifts their level of pay.”